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AKNOWLEDGEMENT: <br /> As owner of the above named property I agree to all terms, conditions, and specifications <br /> outlined in the above permit and in the Town of Albion's Driveway and Culverts Ordinance. I <br /> also acknowledge and agree that I am responsible for any damage to the roadway, shoulder or <br /> right-of-way, which occurs during the construction process, up to and including any time period <br /> until an occupancy permit and/or final inspection notice from the Town of Albion Building <br /> Inspector is issued and received by the Town. I agree that the damage deposit of$1000.00 I <br /> make will be retained until the Town Board acts to release the deposit. Costs for any damage, <br /> solely determined by the Town, will be deducted from the deposit prior to return. <br /> � <br /> Z(- 2 3 <br /> Property Owner Signature D. - <br /> Approval of initial access j ' a l 31 J C <br /> Town Representative Date <br /> Additional Access: <br /> Access granted/denied by the Town Board on: , 20 <br /> Reason for denial <br /> Deposit amount: Type: personal check <br /> money order/cashier's check <br /> Date deposit authorized to be returned by: Public Works Staff: <br /> Town Board: <br /> Date deposit authorized to be held by Town Board: <br /> Date deposit returned by Clerk/Treasurer: <br /> • <br /> Comments: <br /> C:\Users\AMY004\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\JVDQ21M2\DRIVEWAY APPLICATION <br /> PERMIT.docx 3 <br /> 4/24/06 <br />